Increased clinician understanding of cultural hairstyles may reduce traction alopecia

Traction alopecia can be reversed or reduced when clinicians are mindful of culturally sensitive practices and recommend low-risk hair styles, according to a poster presented at the Skin of Color Update virtual meeting.

“Traction alopecia (TA) is a debilitating hair loss condition that affects Black women and children with debilitating hairstyles,” Gabriella Santa Lucia, BS, of the department of dermatology and dermatology surgery at the Medical University of South Carolina, and colleagues wrote. “Hair styles with tight braids, dreadlocks, buns and/or ponytails are at highest risk of hair shaft breakage due to the traction forces creating sites of geometric weakness.”

Researchers completed a retrospective chart review of 164 patients (average age, 31.5 years; 98.2% female; 97.6% Black) with a diagnosis of TA or TA plus androgenetic alopecia (AGA), of which 72% reported a history of braids, weaves, cornrows, dreadlocks, extensions, perms, ponytails, wigs and/or thermal and chemical relaxants.

All patients received therapeutic counseling to address current hairstyling practices and provide alternative choices, while 76.5% also received therapies including topical minoxidil, topical corticosteroids, intralesional corticosteroids, topical antibiotics, systemic antibiotics or platelet-rich plasma.

Following an initial visit, 68% did not return for a follow-up, and of the 32% who did, 78% were lost to follow-up within 6 months.

“Limited clinician understanding concerning traumatic hairstyles’ cultural and societal significance is one potential reason for lack of follow-up rates,” the authors wrote.

Of those patients who followed up, improved outcomes were reported in 63%, while 33.3% had unchanged or stabilized TA and 3.7% had a worsened outcome.

Clinicians should be aware of the personal value of hairstyles and recommend low-risk alternatives as opposed to complete avoidance, according to the authors.

“TA is typically reversible in early stages. A timely diagnosis is critical to maximize therapeutic potential,” the authors wrote.

“These culturally sensitive practices may lead to improved compliance, thereby increasing the likelihood of sustained, positive outcomes.”